Beyond the Family Metaphor: Facility Caregivers Remembering Their Families

Hands-on caregivers in long-term care facilities often describe their work as being “like family.” The literature has not sufficiently explained what like family means. This qualitative study analyzes the reports of 23 facility caregivers about what they found rewarding in their work. Six participants described how they remembered family members while on the job. They remembered family members they cared for or wanted to care for. Family members who had passed away were also remembered by 2 of the 6 participants. Remembering family members allowed participants to feel close to their loved ones and see their work as giving back.     

A Conceptual Model of Family Surrogate End-of-Life Decision-Making Process in the Nursing Home Setting: Goals of Care as Guiding Stars

An increasing proportion of dying is occurring in America's nursing homes (NH). Family members are involved in (and affected by) medical decision-making on behalf of NH residents approaching the end of life, especially when the resident is cognitively impaired. This article proposes an empirically derived conceptual model of the key factors NH family surrogate decision-makers consider when establishing or changing goals of care and the iterative process as applied to the NH setting. This model also establishes the importance of family social role expectations toward their loved one as well as the concept, “stance toward dying,” as key in establishing or changing the main goal of care. NH staff and physicians can use the model as a framework for providing information and support to family members. Research is needed to better understand how to prepare staff and settings to support family surrogate decision-makers, in particular around setting goals of care. The model can be generalized beyond nursing homes.     

Experiences of Young Indian Girls Transiting out of Residential Care Homes

Leaving the residential care home is one of the most significant occurrence in the life of every care‐leaver. It encompasses vast changes which has a long term impact on the care‐leavers future. This study captures the lived experiences of twenty‐four young Indian girls who have left care in the past four years. It addresses their journey of moving out of care at two levels — their preparation to leave care and their present experience. The primary focus of the study is to explore the interpretation and meanings attributed by these girls to the phenomena of transition out of care; identifying the uniqueness and commonalities that emerges from their experiences. The results exposes a plethora of emotions and episodes the girls have encountered at each step of their path. It also emphasises on the role played by multiple environmental factors — support network (friends, peer group, family, social workers, etc.), residential care home, state and other social processes — operating at different systemic levels, highlighting the interface between the ‘self’ and the ‘environment’, based on the Ecological Framework.     

Common Ground: The Development of a Support Group for Survivors of Homicide Loss in a Rural Community

ABSTRACT

Losing a loved one from human-perpetrated violence can lead to a debilitating process of stigma-generated isolation and trauma. Layers of social services are needed to support surviving family members, all secondary victims of homicide. Although urban populations have enriched access to victims-of-crime services, rural-bound populations often do not. This article describes homicide-specific trauma and the development of a community support group for rural-bound persons suffering homicide loss. The support group process offers potential for real help in areas where few trauma-informed options exist. The authors chronicle their journey of group-work practice with underserved persons coping with homicide loss.     

A good death for residents of long-term care: family members speak

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/ assisted living facilities. Structural components of care including staffing adequacy, training, and consistency as well as facility environment and size were important factors for family members interviewed. "Being there" and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

Transnational Caregiving for My Father: An Opportunity and a Blessing

Transnational caregiving can be daunting, yet it often brings out the strengths of the caregiver that he or she may not have been aware of. Thus, it is a wonderful opportunity to know oneself and use those strengths to become better in other areas of life. Transnational caregiving is also a blessing, in that one can still continue to provide care for a loved one by surmounting the barriers of geographical distance. To transform what often is a challenging situation into a blessing, a fresh eye is needed to seek different ways of fulfilling the needs of the loved one by focusing on one thing: How can the caregiver, in his or her individual capacity, make a difference in the quality of life of the family member? This article, while relating personal experience in caring for a parent, traverses these issues.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

Supporting Residents Moving Into Long-Term Care: Multiple Layers Shape Residents’ Experiences

This interpretive grounded theory study explores 10 residents’ retrospective accounts of the relocation process, including the decision to move into a long-term care home, the pre-move preparations, the moving day circumstances, and the initial adjustment period following the move. Analysis of the data revealed a complex intersection of conditions at multiple layers that shaped residents’ experiences of the transitional process. Recommendations to enhance circumstances at individual, interpersonal, and systemic layers, for each temporal stage of the relocation process are proposed. Implications for social work practice across the continuum of care are also discussed.     

Early access and use of housing: care leavers and other young people in difficulty

This paper presents findings from a study of how care leavers access and use housing services, and what they said had helped them to do so. The sample comprised 80 care leavers, and, for comparison, a group of 59 young people (termed ‘in difficulty’) who met certain criteria of disadvantage. Care leavers were found to have fewer crisis transitions and less experience of homelessness, together with a much higher level of autonomy and support in their first accommodation, relative to other young people in difficulty. Several factors are identified that, from the care leavers' point of view, contributed to their better access and use of housing services, including having family and friends to turn to, and leaving care teams that negotiated on their behalf with housing services. The paper concludes that care leavers had more positive housing experiences than other young people in difficulty, helped by the improved preparation for independence and ongoing support available to them from leaving care teams.     

Research Review: Parents' service experience – a missing element in research on foster care case outcomes

A large body of child protection literature focuses on termination of parental rights, family reunification, and children's re‐entry into care as outcomes for children in foster care. Studies have investigated child, placement, family, and parent variables as predictors of case outcome. However, one important group of variables remains largely unstudied: factors related to parents’ service experience. Parents’ service experience includes parents’ perceptions of and involvement in the various services in which they must participate in order to recover their children from foster care (e.g. mandated treatment programmes such as substance abuse rehabilitation, parenting skills classes, etc.). The parental perspective on the foster care process is a critical element in the life of a child protection case, and its influence on case outcome must be explored. A brief review of the current literature on case outcome predictors is provided and parents’ service experience is highlighted as an area in need of investigation. Suggestions for the measurement of parents’ service experience are also offered.     

A qualitative inquiry into women’s experiences of severe maternal morbidity

Severe acute maternal morbidity (SMM) is a near-death experience during pregnancy, childbirth or termination of a pregnancy. Nine women recruited from hospital intensive care or high dependency units following the birth of their baby participated in two qualitative interviews about their SMM experience. The interpretative phenomenological analysis led to the identification of three superordinate themes related to participants: moving from a state of normal pregnancy to being severely unwell, being in critical care and returning to normal. Participants’ transition to a SMM event occurred quickly and was frightening, with participants expressing concerns about their husbands/partners’ trauma. Participants’ time in hospital was particularly hard for those separated from their baby, with this eased by staff kindness and family support. After discharge participants continued to seek explanations for their SMM. Implications include more formal support for mothering when women are in maternal critical care, and support for husbands/partners following a SMM event.     

Family and Friends of People with HIV/AIDS Support Group

ABSTRACT

Those who are supporting a loved one with HIV/AIDS are under a great deal of stress and need support too. This article describes a support group for family and friends living with HIV/AIDS in which members share their personal experiences, educate one another, and in the process, realize they are not alone as they learn to cope with the diagnosis of AIDS or HIV+ in someone they love. The struggles, conflicts, and emotions of the group members and of the group facilitators are discussed.     

Client Suicide

Abstract

Mourning a suicide can be a difficult, complicated experience for family and friends. A therapist's bereavement can be even more complex. The multitude of feelings is often unspoken and/or unattended by colleagues, loved ones, and themselves. This article explores some defenses, both helpful and unhelpful, that one clinician used to process the event.     

The Reaction of the Family to the Institutionalization of an Elderly Member: Factors Influencing Adjustment and Suggestions for Easing the Transition to a New Life Phase

The institutionalization of an elderly person is a crisis for the family. Using case illustrations, this article presents three major factors affecting family reactions and adjustment (the expectations of society, family roles and expectations, and the impact of the move upon daily family life), suggests that nursing home placement be viewed as a step in the normal family life cycle, and discusses ways in which rituals could be used to ease the tradition to the post-placement phase of the family.     

Residential care: an effective response to out‐of‐home children and young people?

The ever‐growing number of out‐of‐home children in Italy over the last decade has urged an assessment of the available care services. Although foster care is spreading rapidly, many young people are still housed in residential facilities. Reflection on residential care quality has intensified at both a national and an international level. This paper presents the results of a study on residential care facilities for children and young people in the region of Northern Italy (Lombardy). Four dimensions of ‘quality’ are considered: efficiency, effectiveness, participation in planning and intervention, and empowerment of children and their family relationships. The combined effects of these dimensions are defined as ‘relational quality’. The results show that residential care facilities are generally good, while Social Services resources often appear inadequate for interventions aimed at birth families (efficiency). The well‐being of children in residential care facilities is high, even if they tend to move from one facility to another, rarely returning to their birth family (effectiveness). The involvement of children and their families at different stages of the care path is limited (participative approach). Finally, the most critical element is the failure to properly involve birth families (empowerment).     

Long-Term Outcome Effectiveness of a Health Promotion Program for the Elderly

A sample of long-term care facilities utilizing ombudsman services was compared to facilities not in receipt of such mediation services. Independent assessment measures were derived from State Department of Health ratings and complaint statistics for long-term care facilities. Findings revealed that ombudsman-served facilities were not appreciably different from facilities not served by ombudsmen. Facilities served by ombudsmen, however, received a relatively higher amount of complaints than did the facility group not served by ombudsmen, particularly in areas not covered by statutory abuse reporting requirements. It is suggested that nursing home patient ombudsmen call attention to aspects of quality care not currently assured by other protective mechanisms.     

Exploring “Home” Through Residents’ Lenses: Assisted Living Facility Residents Identify Homelike Characteristics Using Photovoice

An increasing number of older adults are moving into assisted living facilities when living independently becomes difficult. These facilities afford older adults a home-like environment with opportunities for social activity and a minimal level of professional care, although relocation can negatively impact well-being. Because it is important to study home environments of aging adults, 10 residents of an assisted living facility were engaged in Photovoice to explore perceptions of the facility as home. Through photographic expression, residents identified environment enhancements for home at an assisted living facility. Findings of this study have implications for program planning at long-term care facilities.     

Understanding Ambiguous Loss in the Context of Dementia Care

Abstract

This study examined the experience of ambiguous loss for family members caring for a person with dementia living in a long-term care facility. Data for this study came from in-depth, active interviews conducted with 38 adult daughters and 23 adult sons caring for a parent with dementia living in a long-term care facility. The stories shared by the adult children revealed that ambiguous loss in the dementia context involves a long, on-going process of several phases including anticipatory loss, progressive loss and acknowledged loss. The nature of the ambiguity shifts and the experience changes for families as they journey through the ambiguous loss process. Acceptance and avoidance were the two most common coping strategies used in dealing with acknowledged loss.